Ask the Treatment Expert about ... auditing skin integrity programs

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Jeri Lundgren, RN, BSN, PHN, CWS, CWCN, CPT
Jeri Lundgren, RN, BSN, PHN, CWS, CWCN, CPT

What should our wound care nurse audit, and how often, to ensure our skin integrity program is on track?

At least once a month, time should be set aside for the wound care nurse to audit the skin integrity program. The amount of time depends on the size of your facility.

Select two to three charts per unit for long-term care residents, three to four charts for recently admitted residents, and two to three recent discharges.

When reviewing the chart, have the care plan in front of you so you can update it for identified risks and interventions as you go. Ensure the plan of care was developed within 48 hours of admission and has appropriate, measurable goals. Review the current history and physical, diagnoses list, physician orders, physician/NP visits, MDS section M/CAA, labs, and skin-specific referrals from dietary, therapy, wound consultants, etc. Then observe the resident and resident's environment to verify that interventions have been implemented.

Skin integrity risk assessment should be done upon admission, weekly for the first four weeks, then monthly and with any change in condition. All identified risk factors should be listed on the care plan. All residents should have a head-to-toe skin assessment weekly. Residents with wounds should have the wound assessed at least every seven days. Residents with a planned discharge should have a head-to-toe skin assessment and have any existing wounds assessed on the day of discharge.

Next, review the treatment sheets to ensure proper transcription of the wound care orders and that they are being done and signed as completed.

Lastly, review treatment carts and supply rooms for outdated or opened topical treatment products. I also recommend observing nurses performing dressing changes for proper technique and infection control.

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